消化管アミロイドーシスのX線診断

Radiological Diagnosis of Intestinal Amyloidosis

要旨　（1）アミロイドーシスのX線像を二重造影像を中心に検討した．（2）アミロイドーシス23例を対象にX線像を粘膜模様像と変形に分けて考察した．（3）固定標本レントゲノグラムの粘膜模様を，便宜上3つのパターンに分類した．A．微細顆粒状陰影．B．ひだの変化を主とするもの（ひだの直線化，肥厚，硬化，乱れ，消失）．C．びらん，潰瘍がみられるもの（多発・散在性のバリウム斑を主とするもの，大小不同の顆粒状陰影を主とするもの）．（4）アミロイド沈着の分布および程度，潰瘍の形態に分け，シェーマで示した．（5）二重造影には3つのパターンに対応する像がみられた．（6）変形では小腸には狭小，拡張，ハウストラ様変形がみられ，大腸にはハウストラの硬化像，狭小，segmental signがみられた．（7）そのほかに浮腫およびspasmの像，腸管辺縁の硬化・粗糙，バリウムの付着異常，多彩性，通過時間の遅延などがみられた．（8）粘膜模様は上部小腸では糞線虫症に，下部小腸では腸結核に，大腸では潰瘍性大腸炎に類似していた．（9）粘膜模様は類似していても，変形，罹患範囲，多彩性の点で差がみられた．（10）アミロイドーシスの各所見の組織学的背景は，①粘膜固有層へのアミロイド沈着，②粘膜筋板へのアミロイド沈着，③浮腫，特に粘膜下浮腫，④血管壁へのアミロイド沈着による内腔狭窄→血流障害，⑤神経線維へのアミロイド沈着，これらが重なり合って，種々のX線像が現れると思われる．

　1) Radiological findings of amyloidosis were discussed with emphasis on double contrast radiograph.

　2) Radiological findings were discussed with respect to mucosal patterns and deformity observed in 23 cases of amyloidosis.

　3) Mucosal patterns seen in the fixed specimen roentgenogram were classified into three groups.

　A. Fine granular shadows.

　B. Changes of the folds (straightening, thickening, rigidity, irregularity, disappearance).

　C. Erosion or ulcer (multiple scattered barium flecks, granular shadows of various sizes).

　4) Fig. 2 shows in a schema the distribution and degree of amyloid deposits and the shape of ulcers.

　5) Three patterns were also demonstrated in the double contrast radiograph.

　6) Deformities included narrowing, dilatation and haustra-like change in the small intestines, and rigidity of haustra, narrowing and segmental sign in the large intestines.

　7) The other findings included edema and spasm, rigid and coarse margins of the intestine, abnormal barium patches, and prolonged transit time.

　8) Mucosal patterns resembled to strogyloidiasis in the upper small intestine, tuberculosis in the lower small intestine, and ulcerative colitis in the large intestine, but amyloidosis could be distinguished by deformity, sites of involvement and variety of findings in its appearance.

　9) Radiological appearances of amyloidosis resulted from the following histological abnormalities :

　(1) amyloid deposits in the propria mucosae.

　(2) amyloid deposits in the muscularis mucosae.

　(3) edema in particular submucosal edema.

　(4) narrowing of the vessels due to amyloid deposits in the wall causing disturbance in blood flow.

　(5) amyloid deposits in neurons.

　It was likely that these combined with each other to form various radiological findings.